Thursday, May 31, 2007

I received some interesting, and helpful, info today from Phil Montgomery, of the LIFE Foundation, a non-profit focused on increasing public awareness of life and health insurance issues. As we noted a few weeks ago, May is (was?) Disability Insurance Awareness Month. Phil asked me to pass along some final thoughts: It is estimated that one out of every three workers will suffer a disability lasting three months or more at some point in their career, yet studies show that most Americans couldn't afford to live without their paycheck for even one month before financial struggles would start to mount.

We write a lot about medical insurance, which essentially pays the doctors' bills. But it's important to remember that, if you have a serious illness or injury, you still have mortgage and car payments, light and telephone bills, and all those other monthly expenses to pay. No major medical plan pays those, so do yourself a favor and ask your agent about disability insurance. You'll be glad you did.

"I'm hoping and praying that he's getting the proper treatment, that my daughter is holding up mentally and physically," Cooksey told The Associated Press. "Had I known that my daughter was in any risk, I would not allow her to travel."

Would not have allowed his daughter to travel.

I am not a microbiologist, but I don't think one contracts TB by traveling.

Below from the AJC (requires signing up):

As airline passengers around the world worried about whether they were exposed to the drug-resistent TB, public health experts were trying to figure out how Speaker was able to jet off on his honeymoon with the knowledge of government officials.

The case, which has spawned an international health incident involving investigations in several countries, raises difficult questions about balancing the rights of an individual with the needs to protect the public, they said.

The rights of an individual vs. the rights of everyone else in close proximity. Seems pretty obvious to me.

This guy forfeited his rights when he left the country AMA (against medical advice).

While he was honeymooning in Rome, CDC officials asked him to agree to indefinite isolation in an Italian hospital. Instead he fled. Despite the CDC putting the man on airlines' "no fly" lists and having his passport flagged, the man and his bride were able to elude health authorities and sneak back into the United States by flying to Canada and driving across the border last week.

Well that's a bit disconcerting.

Fulton County and Georgia state health officials said they believe Speaker was clearly informed that he shouldn't travel. But they also acknowledge that despite their conversations, as of May 10 they knew he intended to leave the country for his wedding. They also discussed with CDC officials Speaker's intent to fly for at least two days prior to him boarding a May 12 Atlanta to Paris flight, according to CDC spokesman Tom Skinner and Georgia's state epidemiologist Susan Lance.

And it didn't occur to anyone to put him on a no-fly list then and flag his passport?

Skinner said Fulton County health officials contacted CDC on May 10 and said that Speaker, who at the time was diagnosed with multi-drug resistant tuberculosis, had told them he planned fly aboard airlines. The discussions continued on May 11, Skinner said. "We discussed with them several options to prohibit him from flying," Skinner said. All of those options involved actions that needed to be taken by state or local health authorities, he said.

Reminds me of the Freddie Prinze line from Chico and the Man . . . "it's not my job, man".

Fulton County health officials have said they tried to hand deliver Speaker a medical order telling him he could not travel, but that his home was vacant and he was not at his office when they tried to serve him with it on May 11.

OK, but . . .

The man was on Air France flight 385 from Atlanta to Paris on May 12

So where was he on the 11th?

Why couldn't he be located?

This situation is frightening to say the least. On the surface, you have a self-serving individual who is willing to put his own pleasure ahead of the safety of others, including his new bride. You also have a level of apparent incompetence when it comes to public health officials protecting the general population.

Next week's CoR marks the 1rst Anniversary (by date). So, I'd like to encourage folks to submit their favorite risk-related posts from the past year (if you've already submitted a post, but would rather enter a "fav," just let me know).

The estimable Richard Eskow, blogging at The Sentinel Effect, hosts this week's outstanding edition of the Health Wonk Review. He presents 20 posts, all with helpful context, and an intuitive flow.

Although we here at IB are unashamedly enthusiastic about consumer driven health care, we also know that it's not without its faults. Our good friend Joe Paduda, of Managed Care Matters, presents what he's coined as a "pre-lash" against some aspects of this phenomenon. As usual, it's timely and insightful.

Wednesday, May 30, 2007

We've discussed the new Massachusetts health plan before, pointing out the ginormous cost of the program (exceeding even its critics' worst fears), so it's no real surprise that the Bay State gummint has decided to increase the plans' load: consultant Alan Raymond was contracted to evaluate the program 1 year in, and he finds some disheartening trends:

In theory, Mass Health was supposed to lower the ranks of the uninsured by increased enrollment in Medicaid for those in the lowest income levels, while "encouraging" (requiring, really) all others to obtain insurance through their employers or individual plans.

In reality, according to Dr Raymond, enrollment in Massachusetts' Medicaid program has increased by over 50,000 since last summer. That means that about 54,000 low income folks who had been previously counted as uninsured are now covered. And why not, since the Bay State itself (or, rather, its taxpaying citizens) foot 100% of the tab.

What to do, what to do?

How about a new, even more encompassing state-run plan: Commonwealth Care. This program debuted in January, for folks who make 200% to 300% of the federal poverty level. Now, these folks have to ante up a bit to participate. It doesn't take a Carnac to divine what's happened with this plan: less than 20% of those eligible have opted in.

Quelle surprise!

Now, what could top both of those? You guessed it: The Commonwealth Choice program, set for a July rollout, will purportedly help "higher-income" residents buy "unsubsidized" (i.e. non-taxpayer-funded) private coverage.

A man with a form of tuberculosis so dangerous he is under the first U.S. government-ordered quarantine since 1963 had health officials around the world scrambling Wednesday to find passengers who sat near him on two trans-Atlantic flights.

Government ordered quarantine.

Sounds serious.

Health officials said the man had been advised not to fly and knew he could expose others when he boarded the jets from Atlanta to Paris, and later from Prague to Montreal.

Advised against flying.

So what does he do?

He takes a trans-Atlantic flight, then a circuitous route back home to avoid compliance with orders from the CDC to remain in Italy.

The man, however, told the Atlanta Journal-Constitution that doctors didn't order him not to fly and only suggested he put off his long-planned wedding in Greece.

Oh, that's different.

They never TOLD him NOT to fly, only advised against it.

Let's see.

They told him he had a potentially deadly form of TB that is resistant to the usual treatment protocol. So what does he do?

He boards a plane, with the potential to infect others.

They ordered him into isolation, saying he should turn himself over to Italian officials.

Instead, the man flew from Prague to Montreal on May 24 aboard Czech Air Flight 0104, then drove into the United States at Champlain, N.Y. He told the newspaper he was afraid that if he didn't get back to the U.S., he wouldn't get the treatment he needed to survive.

Nice guy.

After all, it's all about him.

UPDATE: Since writing this piece an associate has provided me with a linkto another, similar situation. This drives home the point about how reckless TB man's actions really were.

Mattioli's doctor is one of thousands of small practitioners who are getting out of the businessof administering drugs for conditions ranging from anemia and cancer to arthritis and infections, forcing hundreds of thousands of patients to get the drugs elsewhere. It is an unintended consequence of a change in the way Medicare reimburses doctors for a class of drugs that are most often injected or infused.

Medicare.

The taxpayer funded, government health care program that is the only option for our senior citizens.

The change is hurting small medical practices in particular because most of them don't buy enough of any one drug to get the big rebates or discounts that drug companies offer to large customers. Making matters worse, Medicare now reimburses doctors based on a drug's average sales price, and the big rebates to large customers have driven down Medicare reimbursements especially for expensive anti-anemia drugs

So where does one go for these meds? Wal-Mart?

Edward Ambinder, one of two doctors in a New York oncology practice, said he loses money on anti-anemia drugs. He pays $528 for one 40,000-unit dose of Procrit, he said, and Medicare reimburses him only $378.

Losing $150 on each patient.

This can't be good.

Doctors who buy their drugs in higher volumes can still afford to treat Medicare patients in their offices. Dr. Frederick Schnell, part of the five-doctor Central Georgia Cancer Care group and president of the alliance seeking corrections to the reimbursement rules, buys enough Aranesp (and Neulasta) to get a rebate from Amgen that provides a profit after Medicare reimbursement of about $47 a dose. Last year, his practice made about $400,000 from Aranesp rebates, he said, which pay for the practice's 20,000 square feet of office space, 60 employees and large pharmacy. ''Community oncologists don't ask for rebates,'' said Schnell. ''They're simply part of the system.''

That's a nice profit.

So all a Medicare covered participant has to do is change doctors if they want their medicine administered.

In addition, some hospitals and doctors used to waive the 20 percent Medicare co-pays for patients who couldn't afford them, but now they're less likely to be able to afford to do so and instead are becoming more aggressive about collecting, squeezing patients financially. For patients who require expensive intravenous treatments, such as certain cancer patients, the co-pays can balloon to thousands of dollars.

Tuesday, May 29, 2007

For the first time in some months, one of our posts is featured in the Carnival of the Capitalists (Yay!). The uniquely named Marketing Whore (sorry) hosts this week's star-studded edition, with 16 entries, almost all with helpful (indeed, copious) context.

Ben at Money Smart Life hosts the 102nd edition of the Carnival of Personal Finance. Replete with interesting (if sometimes obscure) musical references, this compendium of almost 70 posts is music to the eyes. I have but two quibbles: only a few posts had any kind of context, and some links didn't work at all.

Still, I did find the Silicon Valley Blogger's post on valuing Moms (both Stay at Home and otherwise) to be pretty darned insightful (and it's not just because my better half sometimes drops by here). Recommended.

We do, indeed, get quite a bit of email here at IB; some's good, some's interesting, some's spam (or worse). We endeavor to answer all our (legit) email promptly, especially when it comes to claims or coverage issues.

Recently, we received this from one of our readers:

"I have always had a horrible fear of the dentist. I am 46 years old and though it is a tad better, I still tolerate long appointments better with nitrous. At my age, evidently I am all into the "crown stage"...either that or I am paying up someone's college fund.

My insurance will not pay one dime towards nitrous. Why? Medically unnecessary? They'll pay for one or two little pills if the dentist chose to try one of the anti-anxiety drugs (they don't work)."

First off, I am not a big proponent of (individual) dental "insurance:" in almost every circumstance, one is, at best, trading dollars with the insurance company. Think I'm off base? Do the math: waiting periods for anything more involved than a simple cleaning (and sometimes those, too!), deductibles and co-insurance for "major" claims, and an annual cap in the low $1,000's. Insurance companies miss very few tricks. Group dental is also a dollar-trading affair, but may make sense if some/most/all of those dollars are your employer's (if you buy into the theory that employers actually pay for insurance).

Be that as it may, our correspondent raises an interesting question: why is N2O not considered an eligible expense in this scenario? After all, novacaine is okay when you're having a tooth filled, and nitrous is approved for extractions, so why not here?

The easy answer is: because dental insurance is regulated very differently than medical coverage, and carriers can exclude a whole lot more in the former than the latter. Since a benefit that's excluded doesn't cost the carrier anything, there's an incentive to keep as much as possible off the "covered" list.

The more accurate answer is, as the email mentioned, "medical necessity." That is, "treatment which is required to treat or care for symptoms of an illness or injury or to diagnose an illness or condition that is harmful to life or health.” I might add that the industry has often expanded this definition, to include certain obvious comfort-making processes (i.e. anaesthesia for surgery, etc). One can readily see that, although our correspondent may well experience heightened anxiety when visiting her dental practitioner, this does not in and of itself constitute medical necessity.

One possible alternative for folks contemplating dental coverage is to look into an HSA compliant medical plan, and funding dental (and a host of other eligible) expenses through the tax-advantaged Health Savings Account. In this way, Uncle Sam is helping to subsidize your out of pocket, including the aforementioned N2O. And if you're able to shed some anxiety, the money then stays in your account, instead of going to the insurer.

With over 4 dozen interesting posts, the 2nd year medical student who blogs at (of course) From Med Skool hosts this week's Grand Rounds. It's easy on the eyes, and easy to follow, as well, with helpful context and useful categories.

Monday, May 28, 2007

U.S. Senator Hillary Rodham Clinton, laying out her first presidential health-policy agenda since a failed attempt during her husband's administration, said she would bar insurers from ``cherry picking'' profitable enrollees.

Cover everyone.

Sounds great.

Who pays the tab?

EVERYONE.

This is called redistribution of the wealth. Also known as rob Peter to pay Paul.

She said she would reduce the nation's health-care bill by encouraging preventive care to catch and treat diseases early on. The effort would require broad involvement, from insurance companies that could cover routine physicals to businesses that can offer incentives to workers for taking preventive steps, Clinton said.

What about personal responsibility? Requiring carriers to pay for routine services is foolish.

That's like making the roads safer by requiring auto insurance carriers to cover the cost of brakes & tires.

Clinton cited a program by Safeway Inc. The grocery chain, the third-largest in the U.S., has said it lowered its health- care costs by 15 percent for non-union workers with insurance plans that fully cover preventive checkups, such as annual physicals, well-baby care and colonoscopies for older people.

Preventive care works, but why is it the carriers responsibility to pay for it?

Seems there is more to the story than just what Ms. Clinton wants us to believe.

supermarket chain Safeway that focuses on preventive care reduced company health care costs by 11% for nonunion employees in 2006, the San Francisco Chronicle reports. The plan, which was offered in January 2006 to the company's nonunion workers, includes a $2,000 deductible and limits out-of-pocket spending to $3,000 for family coverage. Out-of-pocket costs are partially offset by a company contribution of $1,000 to a health reimbursement account

The HRA is more likely the contributing factor to lowering the cost of health insurance, not the preventive aspect.

Don't you just love folks that only give part of the story?

Hey, isn't that why you read InsureBlog? So you will know the rest of the story . . .

NFIB members also think it is fair to underwrite individuals on a variety of factors that influence health expenses, especially those involving personal behaviors. For example, 89 percent of the respondents said they were in favor of hiking premiums for smokers, and 79 percent say body mass and weight should also be considered in the cost of premiums.

OK, that's a hit.

Still, they don't think any of these factors should be grounds for insurance denial.

And a miss . . .

Seems the folks at NFIB have no clue how much obesity can impact overall quality of life and the way it relates to health issues.

Just last week I talked to a guy in his 40's who was 5' 9" and "about" 450 pounds.

About?

According to him, his only health problem was hypertension and it was in the good range thanks to medication.

Right . . .

He was incredulous when I told him there were no carriers that would accept his application for health insurance. He couldn't believe they would accept smokers but not him.

I couldn't believe he said that.

Rather than forcing employers to provide health coverage to employees, 63 percent think that tax credits are the best approach.

Tax credits are nice, as long as you pay taxes.

Most of the folks who need a break are in the lowest marginal tax bracket and tax credits mean little to them.

Friday, May 25, 2007

Bob, Bill, Mike and I would like to wish all of our readers a wonderful weekend. Please find the time to thank a vet or active duty military person for their service to our country. It's their efforts that enable us to remain " the land of the free and the home of the brave. "

One of the conditions that give insurance underwriters much trouble is diabetes. This is due, in part, to the "elastic" nature of the condition: adult vs juvenile onset, insulin vs diet control, "stick" vs oral, and now (apparently), boy vs girl:

One phenomenon which may be driving this disparity is the finding that so many young women are taking anti-psychotic meds: over the past 5 years, the number of girls 10-19 years old who are on these meds has grown by almost 120%, while young mens' usage has gone up just over 70%. That's a pretty wide gulf. Also disturbing is the use of sleeping aids; 80% more young girls use them now than just 5 years ago. I'd sure like to know why; seems to me that adolescence has always been a pretty stressful time, perhaps especially for girls. Couple that with the growing number of that demographic who are now on ADD/ADHD meds (up almost 75% for the girls), and it's not a recipe for positive long term results. Granted, more boys are on these meds than girls, but the gap is apparently shrinking.

One bright spot: "The slowing of growth in pediatric utilization of ADHD drugs, antipsychotics, and sleep medications from 2005 to 2006 may be a reflection of the concerns raised by reports such as (this)."

Thursday, May 24, 2007

When we discuss transparency in health care (and/or health insurance), we often focus exclusively on the costs (in dollars) of a given procedure or treatment. Sometimes, as with HealthcareFacts, other information (such as outcomes, complications, etc) are available. The challenge is finding non-insurance sources for this information.

Why?

Well, for one thing, a lot of folks are (understandably) reluctant to trust health insurance companies when it comes to their health care. For another, a lot of these are proprietary systems, so they may be of lesser value to those not insured by a given carrier.

The good news, according to USA Today, is that more and more providers are now making more and more information available.

What kinds of information?

"Click on the "Quality Reports" tab at the top of the virtual file drawer and look up coronary artery bypass graft surgery. You'll learn that the hospital's death rate is 2.3%, a shade below the national average of 2.5%. The length of stay is 7.2 days, a tenth of a day longer than the national average, and the charges will total about $75,000, roughly $49,000 for the hospital and $26,000 for doctors."

And that's just for one hospital!

And various states are getting into the act, as well; California's HealthCare Foundation (in partnership with a number of related entities) has a web portal one can use to rate a given hospital's quality of care. The Ohio Hospital Association maintains a website where one can search for specific facilities, or by geographic area, for outcomes and charges. Even Georgia's hospital association has a web presence, where one can compare facilities, costs and quality.

The Fed's have also been busy in this arena: Medicare's website boasts a number of search tools, among which is "Hospital Compare," which enables beneficiaries to identify how well a given hospital is performing. Costs and quality measurements are both available, and one can even print off a handy hospital check list of questions to ask before care is rendered.

It's encouraging to see these tools becoming more sophisticated and available to us consumers. As consumercentric health insurance plans continue to evolve, these kinds of tools are becoming more critical. Timing is everything.

The (Orange) county's Primary Care Access Network or PCAN, will be opening a new health-care clinic in July to help the estimated 200,000 people in Orange County who either don't have medical insurance or don't carry enough of it, said Debbie Belanoff, a PCAN program manager.

Many of those people wind up going to a hospital emergency room, which costs three times more than a typical office visit to a doctor, she added.

This is an idea that could have legs.

So what happens when a patient visits an ER and cannot pay?

Those costs are passed on to other patients, driving medical costs higher for everyone.

Yup! You & I pay.

So if we are going to pay anyway, why not look for a lower cost, more efficient model?

"By law, we can't turn anyone away from the emergency room," said Joe Brown, a spokesman for Orlando Regional Healthcare. "We typically see about 1,700 uninsured patients each month."

That's about 57 patients per day who will pay little or nothing for the care they received.

A typical emergency-room visit costs about $300, while that same visit to a clinic is just shy of $100, Brennan said.

Because area residents would be picking up the tab for the working poor in one way or another, funding a clinic is a better use of resources.

Tuesday, May 22, 2007

While the debate about just how dangerous (or not) cellphone radiation is still rages on, there's certainly a paranoid sect that will snap up anything that claims to "protect them," and this Swiss garb maker is latching onto said opportunity. The briefs are purportedly constructed with threads made of silver, which the company claims will fend off harmful cellphone radiation

Here at InsureBlog we try to put a positive spin on things as much as possible but have not shied away from exposing the dirty side of our industry. Most of the time the dark side has to do with carriers (Stupid Carrier Tricks) or providers (Stupid Doctor Tricks) but we have also been quick to chastise agents that have crossed the line.

It seems that some agents working in the 65+ market have found "creative" ways of generating sales . . . and commissions.

In documents provided to congress evidence is clearly present that suggests that insurance salesmen in 39 U.S. states used illegal or unethical tactics in order to get a signature on the dotted line. Furthermore they were willing to enroll the dead,mentally incompetent, use stolen private information attained from federal records and even impersonate Medicare representatives, to win over another unsuspecting consumer.

As if that were not enough, along comes this little gem.

It is estimated that 1 out of 5 Americans who are enrolled in Medicare are on one of the Medicare Advantage plans, and according to some experts these plans are costing the government more money than are the traditional Medicare plans.

Presumably the dead enrollees are not contributing to this shortfall . . .

It's been a while since we visited the world of Pet Insurance, and after the recent pet food scare it seems timely to revisit the subject.

Thanks to The Industry Radar, we're now aware of the Top 10 Reasons we take our pets to the vet: Skin allergies and ear infections top the list for our canine friends, while our feline companions' favorite travails are urinary tract infections and upset tummies.

Most folks don't have pet insurance, so the cost to treat these maladies is 100% out of pocket (and after taxes). According to the American Veterinary Medical Association, "only a small percentage of pet owners carry health insurance for their animals." The American Animal Hospital Association reports that about 3% of pet owners have purchased this cover. By contrast, almost 10% of Canadian owners, and about 2% of cat owners, bought this coverage (what, no national pet insurance plan?).

Our cousins across the pond are snarfing it up, though: in the UK, about 12% of cat owners, and an astounding 18% of dog owners, bought pet insurance, according to the latest figures.

Most of the plans available here are based on an indemnity model; that is, reimbursement up to a certain, scheduled amount. They're comparable, for example, to the now ubiquitous mini-meds on the "human" market. And the plans seem to be reasonably priced; I've even seen some offered in corporate cafeteria plans [ed: dog insurance, cafeteria plans; are you sure you're not talking about Korea?].

Generally speaking, we use the term "benefits" to describe various things covered by insurance policies. But that's by no means an exhaustive definition; retirement plans, for example, are benefits, and flex-time hours certainly qualify, as well.

Perhaps the newest of these non-traditional "benefits" is "Paid Time Off." According to World At Work "(p)aid time off (PTO) banks help companies increase productivity and lower costs by reducing unscheduled absences." Basically, an employer "deposits" a certain value in an employee's benefit bank, against which the employee can draw; the benefit is that such time off is characterized not as "vacation" or "sick leave," just "time off."

In the event, according to Employee Benefit News, more companies are now installing such banks, and there's an increased interest in implementing them:

Monday, May 21, 2007

FIRE Finance blog hosts a very cool Carnival of Personal Finance, with eye-catching (and relevant) illustrations, and helpful context for each of the 50+ entries. It's even categorized for readers' convenience.

For a while now, my daughter and I have had a standing (well, sitting, really) date for Friday nights: House (the doc ) on USA Network. It's always a hoot to watch the title character arrogantly bully his way toward a solution (kind of a medical Sherlock Holmes). I had never considered the show as a place for financial advice, though, until Flexo pointed out some interesting lessons to be inferred.

Friday, May 18, 2007

As we recently reported, Zero Premium Life is the latest something-for-nothing scheme making the rounds of agents' in-boxes. Today I received this from one of our sources:

The product was supposed to have been approved in six states (CA, GA, NC, SC, PA & VT), but the Departments of Insurance for these states have NOT approved it, and many have posted warnings on their websites:

■ Ohio continues to be asleep at the wheel (as is California, but they have an excuse)

The product's roll-out date was supposed to be May 1st, but has apparently been pushed back a month. FWIW, agents are being charged a $10 contracting fee, yet the names of the carier and the investment group are both being withheld.

NAIFA, ACLI and AALU have published a joint STOLI ALERT [ed: STOLI, or Stranger Owned Life Insurance, was supposed to be dead and buried. Guess not].

OK, so too many Mamba lessons have blown out your hip. You need a new one. You know, one of those new ones made from metal that is used for the hull of the Starship Enterprise. What do you do?

You can cough up the $40,000 or so to have your joint replaced (if you do not have insurance).

Or, you can jet to an exotic isle where the procedure is more like $6000. Add in the cost of air fare, hotel, and a few drinks with parasols delivered to your cabana and you might have less than $10,000 tied up.

Medical tourism has become a hot item for discussion. You can debate the merits & downside either way, but here are some things you may not know or have even considered.

There is tremendous liability to those who sponsor, or even participate in the cost of this treatment. If your employer health plan pays a portion of the cost, and something goes wrong, is your employer (or plan administrator) liable?

Possibly.

What if your carrier pays a portion of the cost?

Same issue.

If there are complications while in another country which require follow up treatment once you return home, who pays for translating your medical records?

If there are complications, how many doctors do you think are willing to go back and correct something a doctor in a foreign country did wrong?

Recently I was asked about health insurance that only covered annual physicals, ER visits and overseas medical.

My response was:

There are no financial reasons for buying insurance to cover your annual exam.

If you go to the ER and are admitted, then you pay for the hospital admission. The time (and dollars) spent in the ER are but a fraction of the cost of inpatient care.

There are carriers that offer overseas medical, but the coverage is limited to events that are not pre-existing, and is intended as a supplement to your traditional major medical.

But for sake of argument, let's say you find such a policy. The cost of the plan would be exceptionally high since only a few people would consider such a plan. The premium would almost certainly approach the cost of a more traditional major med plan, so why even take that route?

So you don't care. That is what you want and nothing will convince you otherwise. Guess what your plan does not pay?

■ And just about a quarter of those surveyed think they'll hang it up at 65

The survey results conclude that employees are still playing catch-up with all the retirement plan options available to them. Perhaps more disturbing: about half of them are pretty skeptical about their company sponsored pension plans, yet they're not really taking advantage of all the personal opportunities now extant (IRA's and Roth IRA's, for example).

In a nod to a recurring theme here at IB, most workers currently approaching retirement are ill-prepared for a long term care claim; a lot of them think they're covered, but most probably aren't.

Wednesday, May 16, 2007

Must be "early bird week," 'cuz Bob Laszewski has this week's terrific HWR already posted. It's got a kind of folksy feel to it, which makes it even more fun to read. And each post benefits from that; it's obvious that Bob read each and every entry carefully.

One of my favorite things about the medblogosphere is how folks can take away something completely different from the same data. Jane Hiebert-White of the Health Affairs blog looks at the same USA Today article as I did, and draws completely different conclusions. Viva la difference!

Tuesday, May 15, 2007

This post has nothing to do with insurance, or health care, or risk management. It does have to do with the burgeoning power of the blogosphere [ed: now cut that out!], and where lines can and/or should be drawn.

By way of example: early on in the life of this blog, I was invited by the Oxford University Press to review a new book on health care and health insurance. OUP very kindly sent me a copy of the book (unsigned) to expedite that endeavor. A little later, Blue Cross of Minnesota sent me a nice little package consisting of a pretty brochure and some kind of granola-type bar thingie (as you can see, I'm not exactly a health-food afficionado). Neither the publisher nor the carrier asked me to write glowing reviews; in fact, I was less than kind to Dr Q (but always polite!). Still later, I had the opportunity (along with several other bloggers) to interview a United States Senator.

So what's my point?

The Wall Street Journal recently reported on the newest blog phenom: "blogola." Simply put, it's companies sending nifty free stuff to bloggers (including airline tickets, IPods and other assorted goodies) in order to build "buzz" about a particular service or product. And it appears that this is having its intended effect: "I hope you like it," wrote Ms. Marie in an email to CBS to flag her "Old Christine" posting. "If there's anything you'd like me to add, just tell me and I will." She signed the note, "XOXO."

To be sure, not everyone involved "rolls over," but it seems to me that there may come a time where that conflict of interest may become important, maybe even unseemly. Whenever there's a quid-pro-quo, explicit or tacit, then there's the danger of an insurmountable conflict, which erodes the blogger's credibility and influence. And really, isn't that what we're selling: we write posts in the hope that we will sway our readers toward a certain conclusion or opinion. We have no super powers, only words. But words mean things and, if we choose to "sell out," what have we really accomplished?

Realistically, it's not terribly likely that Bob, Bill, Mike or I will ever be offered any items of real value [ed: oh really? Ask Bill about that new Porsche]. But both Bob and I have been interviewed by various trade journals, and Mike's had an interesting media experience recently (I'll let him tell you about it when the time is right), all because of IB. So we're relatively insulated from the problem. Still, it does give one pause: how would we handle real blogola?

Monday, May 14, 2007

Our friends at MedBill Manager have taken one of our pet "causes" (health care transparency), and given it a thorough re-working. What they've designed is a system which incorporates pricing information with real-time provider searches and provider coding.

On the one hand, I really like the idea that states are trying out different iterations of "universal health care" [ed: a major misnomer, BTW; what they mean is "universal health insurance"]. Constitutionally, it's the only legal way to do this, and it has the benefit of being a smart method, too.

Why's that?

Well, if one state tries a given program, and it's a loser, then only the folks in that state are substantially affected. If one such program turns up a winner, then other states can adapt it to their own population. Kind of a win-win.

Thus far, unfortunately, we haven't seen a successful model, but at least the states are still giving it the old college try. Among the latest is Illinois' plan, which was predicated on a massive tax hike (a $7.6 billion "gross receipts tax" on Prairie State businesses) that was supposed to fund the new program, such as it was.

To get an idea of just how badly this whole campaign went down, one need only consider that the state's House of Representatives (an overwhelmingly Democatic body) buried it with a unanimous (107-0) "no" vote. Yikes!

Of course: businesses (large, small or in-between) don't pay taxes. So the tax hike would have led to major costs being borne by the actual taxpayers, aka consumers. Notice that the article doesn't even really explain the nature of Governor Blagojevich's health care program; it focuses solely on the funding of it. Kinda tells us all we need to know.

First up, the Carnival of Personal Finance. Madame X (of My Open Wallet) presents the 100th edition of this venerable blog compendium. Keeping with this theme, she hosts 100 entries, in 9 distinct categories, and all with great context.

Daniel Goldberg, a second-year PhD student in medical humanities, is out of the gate a day early with his edition of Grand Rounds. Nothing wrong with that, of course; just took me a bit by surprise. In the event, he's got 30 interesting posts; a good mix with helpful comments.

This one caught my eye, at first for the title, but mostly for its "who knew?" factor (although the blog's name itself should be a clue). Go ahead, click it; you know you want to.

Saturday, May 12, 2007

Remember how much you looked forward to birthday cards from relatives? Not so much the card, but the money that was in them.

Now relatives can continue the giving long after they have gone.

Commemorative Life Insurance Company in conjunction with Assurity Life make it possible for your loved ones to continue receiving cards, and money, for as long as they live. Lifetime annual gifts are available in denominations of $100, $250 or $500. You can name as many, or as few, beneficiaries as you choose.

■ Nine out of ten workers underestimate their own chances of becoming disabled.

■ Nearly 60% of workers have not discussed how they would manage an income-limiting disability.

■ Nearly two-thirds of respondents with 401k or IRA plans are unaware of what would happen to their retirement savings should they become unable to earn an income.

■ Female workers, particularly unmarried women, are less likely than males to feel confident that they could pay their living expenses for three months if their wages stopped.

This is not a pretty picture. Working folks are much more likely to suffer a disability than die, yet most of us have at least some group life insurance through our employers. Disability has been called "the living death," because it can quickly reduce one's savings due to lost wages and extra medical and support expenses.

So what can you do about it? Talk with your agent (you do have an agent, right?) about this important coverage. Check at work to see if there's a plan in which you can participate. It's important.

Thursday, May 10, 2007

The issue of prescription drug costs has grabbed state legislative attention and popular headlines for half a decade. But in the fall of 2006 the topic took on a new aspect, when Wal-Mart announced a start-up program offering deeply-discounted $4.00 prices for a 30-day supply for a diverse list of generic prescription drugs.

When consumers of health care become better buyers, all of us benefit.

We've written before about health care discount cards, and the generally low esteem in which we hold them. There are times, of course, when they're appropriate, but I find the marketing gimmicks to be (at the very least) misleading: "All health conditions covered," and "no waiting periods," for example. Of course such plans are in effect immediately, for pretty much any condition: they're not insurance, so there's no underwriting.

But the latest iteration really set me off. See if you can spot the offending "benefit:"

Catch that second line? "Any citizenship status accepted" No matter what one's take is on the current state of either health care or health insurance, it boggles the mind that these folks are encouraging people who are here illegally, and misleading them, as well. This is offensive, and yet there's precious little that can be done about it.

Why, you ask?

Because these are not insurance plans, state departments of insurance have little (if any) power to regulate them [ed: not necessarily - see comments], or even hold them accountable.

Wednesday, May 09, 2007

The May 9th Wall Street Journal [subscription required] features a front-page article that illustrates some of the adverse financial, productivity, and social implications that arise from lax disability certification rules and inadequate standards of approval for disability insurance benefits. The article focuses on Sweden, where benefits for disability are insured by the Swedish government. Sweden is clearly in a corner and must now reduce or withdraw benefits that the people have naturally come to believe they are entitled to have. This won't be easy:

Work? B-b-b-b-but isn’t health care a right? Why should Swedes (or anyone else) have to work for their rights? How can anything be a right if you have to work for it? Say it ain’t so, Lars!

Two other statements in the article caught my eye. First this:

“Swedes are among the healthiest in the world, according to the World Health Organization. And yet 13% of working-age Swedes live on some type of disability benefit – the highest proportion on the globe.”

Seems a reassessment is in order. Meanwhile WHO looks ridiculous.

And near the end of the article, where so often one can find the truly interesting facts of a story . . .

“Everyone who said they were sick was getting money. We didn’t demand anything’ said Ingrid Nilsson, the local agency’s director. ‘I guess that was the wrong thing to do."

Gee, ya think?

Anyone remember the Seinfeld episode when George was fired for a certain kind of after-hours misconduct atop his supervisor's desk, and then plaintively asked “Was that wrong? Was that wrong? No one told me that was wrong.”

So yeah, Ingrid, that was the wrong thing to do.

The Journal continues to report facts that individuals committed to the notion of government control of the health care and health insurance systems like to disparage or ignore.

Unfortunately the Journal's reporting reflects reality, which we ignore at our peril.

First, "what hospitals charge" and "what uninsured folks pay" are two entirely separate things. Providers (not just hospitals) enter into agreements with insurers (or MCO's) which set the terms for reimbursement of services. The providers offer to discount what they charge, and the insurer/MCO agrees to pay that full amount in a timely manner, and to "steer" its customers to that provider, thereby increasing its sales volume. It gets even better with Medicare/Medicaid, because the gummint itself sets the price; no negotiations necessary.

Pretty simple, even for a journalist.

An uninsured person has no such agreement, and has little (if any) leverage. Many folks will (attempt to) negotiate with a provider, with limited success. One sees this especially in maternity cases, where the date of future service is pretty easy to define, and prepayment may be an option. It's pretty hard, though, to negotiate with the ER crew while you're having a stroke.

Which is not to say that I'm unsympathetic; it's a matter of economics and contract law. The providers have an agreement with the insurers, and none with those who are uninsured. For their part, they have little leverage with the patient: the law requires that they treat emergency cases regardless of insurance status, but they are restricted in how they can collect if a patient skips out on payment.

Of course, the cost of the skippee's treatment will be passed on to the rest of us, much as the cost of shoplifting is at KMart (or wherever). One can argue about the fundamental "fairness" of such a system, but it's what we have.

The point [ed: Yay! We knew there'd be one!] is that uninsured folks don't actually "pay" 3 or 4 or 5 times what an insured patient does: just because they're charged more, doesn't mean they pay more.

I also loved this: "The gap between what the uninsured and other self-paying patients are charged for hospital care and what Medicare pays has more than doubled in the past 20 years." Um, what hasn't? Again, it's simple economics, this time coupled with everyday politics: pretty much everything costs more (in raw dollars) now than 20 years ago. Of course, we're making more money than we did back then, too. And Medicare reimbursement fees are set by the gummint, and are applicable to Medicare patients, who -- bydefinition! -- are insured. Nice job of muddying the waters, USA Today!

And finally, there's this gem: "Hospitals provide $25 billion a year in uncompensated care every year." Um, no they don't: they pass along those costs to their insured population. I suspect that Stephanie Armour (the author of the silly piece) also believes that the government subsidizes health care, and employers pay taxes, as well.

Tuesday, May 08, 2007

There's no public or private health insurance plan in the country that could afford to pay for all of the latest cancer drugs, Ontario's health minister said Wednesday amid criticism from patients paying for expensive drugs not covered by the province.

Not covered by the taxpayer funded plan.

Not covered by private insurance.

Bummer.

``In a world where there will be a new product available every day which sometimes is offering very, very modest enhancements to life, measured sometimes in days it's going to be very, very challenging for any insurance system, public or otherwise, to be in a position to buy every product that is out there, he said.

Maybe the folks pushing for Medicare for All here should take note.

The Cancer Advocacy Coalition of Canada says many patients have complained that they were forced to pay tens of thousands of dollars for drugs recommended by their doctors that are not covered by the provincial health insurance plan.

Not covered by the Provincial Health Plan. What happened? The tax machine run dry?

``I must say I was stunned at the prospect of a $32,000 personal expenditure for an approved drug to be administered in a hospital, said Roman Gawur, 57, of Toronto, who was diagnosed with colon cancer last October.

``I guess this health card was not really all that good after all. What I really needed was my Visa card.

That's one heckuva line of credit. Sounds more like a second mortgage to me.

I wonder how many will migrate south, looking for jobs with benefits to cover their medical needs?

The Blog That Ate Manhattan hosts a lovely and large 'Rounds, helpfully categorized and with helpful context for each post. It's obvious that the good doctor has read each and every submission, which must have been no mean feat: there are over 40 of them!

Hoosier smokerswill subsidize a major state health insurance program, as well as other health care improvements, under a bill approved late Sunday by the Indiana General Assembly.

Sin tax.

I like it.

People who earn $20,420 a year, and families of four who earn $41,300 a year, would be eligible. The program is not an entitlement, which means it is available on a first-come, first-served basis.

So, those who are eligible actually have to take the initiative to sign up for the plan.

Wonder how many will fail to put forth the effort to sign up?

Those who participate will receive three levels of insurance. First will be $500 in free preventive care per year such as mammograms and annual checkups. Then the state and the participant will contribute, depending on income, to a $1,100 health savings account for medical expenses such as prescription drugs. The final component would be annual coverage worth a maximum of $300,000.

Monday, May 07, 2007

It is true that health costs are rising fasterthan the inflation rate. But rising costs, even of "essential" products and services, such as food, health care, and national defense, do not necessarily demonstrate the existence of a problem. Costs may be rising because quality is rising, which is true of health care (new and better therapies and diagnostic tools), or because demand is rising (and average cost is not flat or declining), which is also true; as people live longer, their demand for health care rises because more health care is required to keep people alive and healthy the older they are. In addition, much health care is in fact discretionary (cosmetic surgery is only one example; others are treatment for mild depression and other mild emotional or cognitive problems and treatments designed to enhance athletic ability), and demand for it can be expected to rise if quality rises relative to price.

Wonder if Mr. Posner reads InsureBlog?

It is also true that Americans spend much more on health care on average than the people in other wealthy countries do, without greater longevity to show for these expenditures. But health care does much more than extend life; it alleviates pain, discomfort, disfigurement, limited mobility, visual and hearing impairments, and mental suffering, and it is not clear that foreign health systems, which also involve considerable costs in queuing, do these things as well. In addition, the better a nation's health care is, the riskier the population's life style is likely to be, because the cost of obesity and other risk factors for disease is less.

Sure seems like it.

Also misplaced is concern that the United States is becoming less competitive because employers pay for their employees' health insurance, rather than the government. Employers do not really pay for their employees' health insurance; employees (and the taxpayer, who subsidizes employee health insurance) do, because by raising labor costs employee health insurance reduces the wages that employers are willing to pay. Employers who committed themselves to assuming open-ended obligations for employees' (including retired employees') health costs have only themselves to blame for having assumed a risk that has materialized because of the rapid growth in those costs.

So the good news is that he doesn't have cancer, but the bad news is that he thought he did. Having seen what happens to those unfortunate enough to suffer pancreatic cancer (not to mention those loved ones left behind), this is no laughing matter. But it's also a warning that, when faced with a "fatal diagnosis" (okay, no diagnosis ever killed anyone, but it's a great turn of phrase, no?), a second opinion would seem to be in order, wouldn't it?

The story doesn't elucidate on this point, but it seems to me that, had a second opinion been sought, a whole lotta trouble could have been avoided:

"John Brandrick, 62...decided to spend his remaining time in style, quitting his job and spending his savings on hotels, restaurants and holidays."

Now he's seeking restitution from the medical providers who "done him wrong." Given that this is a government-run operation, however, one has to wonder about his odds:

For its part, the hospital (The Royal Cornwall Hospital's NHS Trust) declaims any negligence. Since I'm neither a Barrister nor a Solicitor, I have no idea whether or not that will prove to be an insurmountable defense. Guess we'll have to wait and see.

An outstanding Carnival of Personal Finance is available at The Tao of Making Money. Golbguru (who informs us that golb is "just the word ‘blog’ read from the wrong end") presents 55 interesting posts, in a dozen (clickable) categories.

As a big fan of snopes, I really appreciated Poorer Than You's fisking of the "No Gas Day" pseudo-boycott. Not only does hostess Stephanie debunk the concept, she also suggests potentially viable alternatives. Yay!

On a personal note, this will be my last 'Dispatch (at least for a while): it's been a terrific experience, but it's taking too much of my time of late. Still, I highly recommend that IB readers continue to stop by Trusted.MD for interesting and unusual offerings.

Thursday, May 03, 2007

Ultimately all health care is paid for by business activity. Business provides the wages, the return on investment, the insurance, the taxes that pay directly for health care, and the insurance and taxes that fund government programs. When the government manages to provide services at all, it can give you nothing that it does not take from you or others, or from your employer and other employers. The total added value the government creates for your benefit is nothing.

“Health care is not a right in the United States,” she said. “... You have the right to the pursuit of happiness and whatever, that’s all written in there, but there’s no place that says ‘health care is a right.’”

Whew! I thought they were going to say that health care IS a right, as guaranteed by the U.S. Constitution.

Smith said that in the U.S., instead of a being a right, health care is a business with a bottom line

Apparently Ms. Smith believes health care is NOT a business in other countries. Wonder which government class taught her that?

She said hospitals raise health care costs because of the money they lose treating large amounts of uninsured citizens, causing the insurance companies to charge more for those who are insured in order to cover the higher costs.

At least she got that part right.

The proposal that stirred the most discussion in the audience was WHSA, a single-payer system that is much like what is found in countries like England. Andrew Robson, the associate dean of the College of Letters and Science, was the second speaker of the night. He told of his first-hand experience with England’s universal health care system.

He said that the single-payer system is less stressful, cheaper and simpler than the United States’ current system.

Less stressful to whom? (Or is it who)?

Somehow I doubt the folks in a queue for extensive testing or elective, but necessary surgery will agree.

Burnett said that she disagrees with the health care system in Great Britain and thinks that it is not a good solution because it limits people’s choices and causes lower quality care.

Looks like a counter-point to me.

She said there would be great benefit in a form of universal health care that resembles the Medicare system, which she described as universal health care for seniors.

Ahh, yes. The Medicare for all proposal.

Methinks she does not understand just how poorly Medicare works and how expensive it is for both the taxpayer and the beneficiaries.

Granted, to receive Medicare you do not have to qualify from a health standpoint, but you still must have the funds to fully take advantage of the system.

Only Part A is "free" and even that comes with a price in the form of deductibles & coinsurance. Parts B and D require a premium payment. Then if you want coverage to SUPPLEMENT what Medicare does NOT pay, you pay again.

Another concern was that hospitals would be overflowing with people who were not covered by insurance before, but now want to get care because they are able to.

When something is perceived as free, demand outstrips supply.

Just offer free tickets to the World Series and see how many folks show up.

In honor of the 133rd Run for the Roses, we present the Thoroughbreds of Wonk. Thanks to the expert grooming of Joe and Julie, the Health Wonk Review is a blog carnival of a different color. Thanks, too, to all the bloggers who submitted almost 20 posts. In keeping with the spirit of the Review, though, I had to turn some in to the glue factory. What's left are the true champions.

And now, I'll stop horsing around, and it's off to the races:

■ Richard Eskow presents A Brief History of Capitation, From Medieval Days to 21st Century Reform. Richard considers the policy implications of provider capitation with a history lesson that moves through ancient China, the Norman Conquest, the 1980's, and other long-forgotten eras.

■ Writing at the Health Business Blog, David Williams tells us about generic biologics. So what's a "biologic," generic or otherwise, and how will they impact medical costs? Well, I'll let David explain.

■ Rob Cunningham, blogging at Health Affairs, offers a useful primer on the Prescription Drug User Fee Act, currently under debate in Congress.

■ Over at Health Care Renewal, Roy Poses writes about the fall of the Allegheny Health, Education, and Research Foundation. It’s a cautionary tale about what happens when health care entities adopt questionable business practices.

■ Meanwhile, Jon Coppelman of Workers Comp Insider gives OSHA low grades in acting to protect food workers from harmful and potentially fatal exposure to popcorn flavorings, the so-called "popcorn lung." While science points to compelling evidence linking the additive to the illness, OSHA's response has been lackadaisical at best.

■ Finally, here at good ol' InsureBlog, you'll find my take on a recent Gartner Group study about the future of health care consumerism. Be warned, I chose the title on purpose.

Well, that's all for this edition of the The Most Exciting Two Minutes in Blogs. Bob Laszewski at Health Care Policy and Marketplace Review hosts the next one, coming up on May 17th. Meantime, relax and enjoy a tall, cool one: